Surgical antibiotic prophylaxis use and infection prevalence in non-cosmetic breast surgery procedures at a tertiary hospital in Western Australia—a retrospective study

Copyright 2018 Lavers et al. Background. Surgical site infections (SSIs) are a common complication following breast surgery procedures, despite being considered a clean surgery. The prevalence of SSIs can be minimised with the appropriate use of antibiotic prophylaxis as outlined in the Australian Therapeutic Guidelines (eTG). The aims of this study were to evaluate adherence to the eTG for antibiotic prophylaxis in breast surgery procedures at a Western Australian teaching hospital following an update of the guidelines in 2014 and examine the impact of prophylactic antibiotics on SSI incidence and length of hospital stay. Method. A retrospective cross-sectional study which reviewed medical records from a random sample of 250 patients selected from 973 patients who underwent breast surgical procedures between February 2015 and March 2017. Results. Overall adherence to current eTG occurred in 49.2% (123/250) of operations. Pre-operative and post-operative antibiotics were prescribed in 98.4% (246/250) and 11.2% (28/250) operations respectively. Adherence rates to three specific elements of the eTG (drug prescribed, drug dosage and timing of administration) were 91.6% (229/250), 53.6% (134/250) and 86.4% (216/250) respectively. For the 14.4% (36/250) patients with relevant drug allergies, there was zero adherence to the eTG. Overall recorded SSI prevalence was low at 5.2% (13/250). The mean length of stay in patients (2.3 ± 1.7 days) was not influenced by level of eTG adherence (p = 0.131) or SSIs (p = 0.306). Conclusion.These data demonstrate a significant improvement in overall adherence to the eTG from 13.3% to 49.2% (p = < 0.001). The level of detected SSIs in this study was low. Further improvement is necessary with respect to prescribing appropriate antibiotic dosages and for those with allergies

A prescription for resistance: Management of staphylococcal skin abscesses by general practitioners in Australia

Objectives: We investigated the management of staphylococcal abscesses (boils) by general practitioners (GPs) in the context of rising antibiotic resistance in community strains of Staphylococcus aureus. Design, Setting, Participants: We analyzed patient-reported management of 66 cases of uncomplicated skin abscesses from the frequency matched methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) Community-Onset Staphylococcus aureus Household Cohort (COSAHC) study (Melbourne, Australia, 2008-2012). Susceptibilities in all cases were known: 50/66 abscesses were caused by MRSA. In order to investigate GP-reported management of staphylococcal abscesses, we surveyed a random subset of GPs, from the COSAHC study (41), and of GPs (39) who used the same community-based pathology service (December 2011-May 2012). Main outcome measures: Patient outcomes, antibiotics prescribed, antibiotic resistance profiles of infecting strains, rates of incision and drainage (I & D), and attitudes to ordering microbiological cultures. Results: MRSA was three times more likely to be cultured from an abscess than MSSA. Patient-reported management revealed 100% were prescribed antibiotics and only 60.6% had I & D. Of those 85% who remembered their prescription(s), 81% of MRSA cases and 23% of MSSA cases initially received inactive antibiotics. Repeat GP visits where antibiotics were changed occurred in 45 MRSA and 7 MSSA cases, although at least 33% of subsequent prescriptions were inactive for the MRSA infections. Patients treated with I & D and antibiotics did no better than those treated with only I & D, regardless of the antibiotic activity. In the GP surveys, 89% reported I & D, with or without antibiotics, to be their preferred management. Only 29.9% of GPs would routinely swab abscesses. Conclusion: The recommended management of uncomplicated Staphylococcus abscesses is I & D without antibiotics to reduce exposure to unnecessary antibiotics. In our study, I & D was performed in only 60.6% of 66 patients, and antibiotics were always prescribed. The prescribed antibiotics were frequently inactive and often changed, and did not appear to affect patient recovery. Our results show that community GPs can confidently reduce their use of antibiotics for patients with skin abscesses and should be aware that MRSA is a much more common in this type of infection

Nocardiosis at a London teaching hospital: Be aware and beware of what is rare

Aims To review all laboratory-confirmed cases of nocardiosis at a tertiary referral hospital over an extended period (2000–2018; 216 months) with regard to microbiological and epidemiological characteristics, risk factors, clinical management, morbidity and mortality. Methods The medical records and microbiological data of all laboratory-confirmed cases of nocardiosis, identified by culture (with reference laboratory confirmation) or identified in a reference laboratory only, were included and analysed retrospectively. Results 18 cases of nocardiosis were identified; 72% (n = 13) were male; all were UK resident. Median age at presentation was 56 years (range 6–83 years). Most had underlying pathology or risk factors including cancer in 39% (n = 7) and immunosuppression in 33% (n = 6). Alcohol and acid fast bacilli (AAFB) microscopy performed in 8/18 cases was negative. Routine 48-hour bacterial culture of 18 isolates was positive in 15; 3 culture-negative specimens were subsequently confirmed positive in a reference laboratory. Four patterns of clinical presentation were observed: cerebral 39% (n = 7), disseminated 28% (n = 5), pulmonary 17% (n = 3), and isolated cutaneous/articular (both n = 1). In addition one case of bacteraemia was noted. Nocardia farcinica accounted for half (n = 9) of all nocardia species identified. 55% (n = 10) required surgical intervention. One co-trimoxazole resistant isolate was identified. Morbidity and mortality were high: 78% (n = 14) required critical care. More than half of patients (55%; n = 10) died from refractory infection, including all of those with disseminated disease (n = 5). Conclusions Nocardia spp should never be regarded as a contaminant or commensal organism in clinical specimens. Correlation of clinical and radiology findings plus risk factors are imperative for nocardiosis to be considered in the differential diagnosis in order to guide appropriate laboratory processing of specimens. Although rare, recognition of nocardiosis is important because of its high mortality. Routine 48-hour bacterial culture does not always identify Nocardia spp and isolates should also be sent to a reference laboratory

Impact of an antimicrobial stewardship interventio n onappropriateness of prescribing for community-acquiredpneumonia in an Australian regional hospital

Community-acquired pneumonia (CAP) is the second commonest indication for antibiotic use in Australian hospitals and is therefore a frequent target for antimicrobial stewardship. A single-centre prospective study was conducted in a regional referral hospital comparing management of adult patients with CAP before and after an educational intervention. We demonstrated a reduction in duration of therapy and reduced inappropriate use of ceftriaxone-based regimens for non-severe CAP